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Re: American Health Care

Hi. Maybe I can weigh in. I used to work in healthcare and have recently been scarce here on the board as I seriously injured my left forearm near the wrist. This required surgery and a permanent titanium plate and screws to repair my shattered radius. I am also currently going through physical therapy and still require some meds. In other words, I have used my insurance to most of its extremes lately.

As Todash eloquently explained, the services for the uninsured are not the best here. Medicare is for those over 65, or in some cases those determined disabled. My mom qualifies for this as she is 60 but suffers from a disease that has kept her from being able to work. In most of those cases, however, this coverage is provided via Medicaid. Medicaid is funded via the Medicare fund, but is a disbursement given to each state. The state then funds a portion too and it is provided to low income persons, people like my mom and for some services such as nursing homes. To qualify for it, however, you have to be almost destitute or completely helpless.

If you have nothing, which often happens to those who are in the area that isn't poor enough, but too poor to afford private insurance, illegal immigrants, etc., the you can go the emergency room for serious injuries or go to the "free clinic" or "DHS" that counties (or parishes) provide via state and Medicaid funding. You can get immunizations there, women's checks (PAP, etc.) and some basic services. It is mostly free, but sometimes involves a small charge of a few dollars. A newer thing for basic cold, flu, sinus infections, etc., are "Minute Clinics" in large chain drug stores. They will diagnose basic illnesses for free via nurse practitioner and write you a prescription for basic antibiotics. Beyond that, if you are seriously injured (as I was) the options pretty much suck. You are in the hands of charity at that point.

So my recent experience: I have employer insurance, and comparatively good insurance. I have my whole family on it and pay about $200/week for health, dental and vision. It has a deductible of $500 per person and $1500 for the family. That means that for covered procedures I have to pay the first $500 out of pocket and then 20%. The coinsurance (the 20%) and the copays (like the $25 Todash mentioned, mine is $20 for regular docs, $40 for specialists) each count toward the out of pocket max, which is $2500 per calendar year for everything. That basically means that if I was to have a major illness or injury, the most I am supposed to pay for the services, etc (that are COVERED) out of my pocket is $2500 for everyone covered for the year. This does NOT include the weekly premiums I pay for the insurance in the first place. So in reality, for a major thing, with premiums, around $10K a year would come out of my pocket, but none of that includes meds on most plans. Confused yet? Therein lies the problem and the debate.

Before the health care law that was so maligned by the neocon windbags, there was almost no way to know how much something would actually wind up costing you and also very hard to determine what was covered at times.

My surgery had a retail price tag of around $35000. since my surgeon was "in network" they write off a huge portion of the cost and for everything it has wound up costing me around $1500 out of pocket. The other jacked up thing about this is the surgeon,m facility and even the surgical staff and anesthesiologist all bill separately and may or may not be "in network"!! I actually got a bill fro the anesth for $9000 for putting me out. This is because the insurance said his fee was too high and decided he was not in network, even though he works for the surgical facility that is!! HUH?!?!?!??? This can be remedied by making some calls, etc and many hours of dealing with these jokers, but imagine when you're recovering and not well trying to deal with all that crap. And this is WITH good private insurance. It's a joke frankly.

When you lay it out with a real world scenario like this, you can see why many of us are effin' sick of this sh!t and demand national health care. As a matter of fact, the simple reason that I never actually know how much it will wind up costing me in the end to see a doctor, has made me avoid the doctor for many years now. I go in for a yearly check, but if I get sick, I just tough it out typically. This is because insurance companies will do everything they can to deny anything they can. Because it's all for profit. No one has ever been able to explain how a for profit company who does better if you pay in and they don't pay out, could ever have my best interest at heart if it is less profitable for them to pay for the treatment needed. Beyond that, the only argument those opposed to "Medicare for all" essentially boils down to the providers are greedy and don't want to control their fees because that is "anti-american" somehow to do so.

In short it's all a confusing expensive mess, driven by greed first and with a low emphasis on the best thing for the consumer.

Re: American Health Care

Wow Hossenpepper...I have a migraine just reading that! I guess these are the reasons why I'm so confused when I try to make sense of the system, it doesn't make any sense. I hope people are not thinking I'm trying to suggest our system and/or country is better, I know there are many things we lack as a country. I just think it's a shame that everyone can't access decent healthcare.

Re: American Health Care

Originally Posted by hossenpepper

As Todash eloquently explained ...

Ooh, I love it when I'm accused of eloquence.

So my recent experience: I have employer insurance, and comparatively good insurance. I have my whole family on it and pay about $200/week for health, dental and vision. It has a deductible of $500 per person and $1500 for the family.

Just to clarify, my $200 a month is just for me. My husband pays for his own through his work, and it's about the same. This means we have different insurers, but since both our workplaces penalize heavily if you need to cover more than just yourself, I am not complaining about the minor inconvenience. I feel fortunate that we have the option so that instead of paying $600 a month, we are just paying $400.

This is because insurance companies will do everything they can to deny anything they can. Because it's all for profit. No one has ever been able to explain how a for profit company who does better if you pay in and they don't pay out, could ever have my best interest at heart if it is less profitable for them to pay for the treatment needed.

THIS. The more ways an insurance company can find to deny your claim, the better for them. They make money by refusing to pay for your treatment. It's revolting. It's GHOULISH. And I'm disgusted, DISGUSTED, that so many in our society can't imagine there could ever be anything more important than the almighty dollar.

Those who don't have insurance are in a precarious position. Those who do are mostly fine--as long as they don't ever actually need it for more than routine health care.

Re: American Health Care

Wow. Reading all of your entries makes me appreciate my insurance carrier, Kaiser Permanente, a heck of a lot more. President Obama always cites Kaiser as a model for all insurance providers with good reason. Unfortunately, it's only found in California, Oregon, Arizona, Colorado, Maryland, Virginia, Georgia, and Hawaii and then only in the big metropolitan areas of those states.

Re: American Health Care

Originally Posted by PatInTheHat

Yeah that would be the responsible thing to do, pay every single discretionary ducat you have to the overpriced, over lauded, under performing, 24/7 butt covering, takes no responsibility (because it's the "practice" of medicine you silly gooses) American health care system, that is, and whatever's left over, go buy yourself somethin' pretty, like light maybe.
Your plan with the six large worth of a deductible (the size of which also lowered your initial premium costs I take it, not to mention your co-pay), is well beyond those I think your speaking about meager budgets, with or without electronics, thus, with a lower deductible in a range they might be able to meet, how much more would they have to cough up every single month (and we're not counting those fun fun fun for the whole family premium rate increases, which oddly do not so very often correlate with many folkens pay raises..*SNRT!* yeah that one was a pretty freakin' good one, wuddnit?) , and thus give up, hmm, well what else, perhaps shoes, refrigeration?
By the way, who is your insurer?
See I got kin up in Cincy that could really use a lower premium, and yours, even with that hard deductible, is scratch & dent bargain basement, and as for what my insurance would be right at this moment, well, I don't think even has a dollar number coined for it yet, so big kudos & props to you, and though it almost sounds like a waste of good hard earned dough, well you know, if it wasn't for that beat down of a deductible, I toast to your very good health!

I get my insurance from Medical Mutual. I had 90% of my deductible written off by the hospital (I had to have a few expensive tests done) because I have a low income. Get tests done at the hospital instead of private offices and you won't have to pay your deductible if you have low income.

Re: American Health Care

Just for the record, when my accident happened I was on Humana for health, dental and vision. My company switched at the first of the year to a large group Blue Cross/Blue Shield plan that is essentially the same as the Humana plan. I also live in Florida... God's waiting room. I basically pay more for less coverage than I would someplace else like California because younger, healthier folks take up the cost of insuring older people that tend to use much more of the healthcare resources than I, or those like me, would. It is also much harder to get in to see a doc, etc. due to the huge elderly population here.

This is caused not only by the demographic of this state, but by another effed up things about our health care system; the laws and coverages vary and are governed differently in each state. This is yet another reason we needed a national health care law.

This trails into another fundamental American debate about states' rights. I am just of the opinion that I shouldn't have to be under a different set of basic laws as I go from state to state. It's one country and since it isn't 1825 anymore, maybe it's time to grow up as a society and act like it's only one.

Re: American Health Care

When we actually get our insurance cards in, my husband works for an insurance company, and has spectacularly good insurance. It's 300$ a month for the two of us with 10$ regular doctor, 25$ specialist, and 50$ emergency room visits. My brother-in-law works for the same company and he and my niece are pretty sickly (really severe allergies), and they haven't denied anything yet.

I had no insurance for a long time because the insurance that was offered by my job was terrible, and I was mostly healthy until the last year or so (beyond the depression anyway). I also just simply couldn't afford it. There are free clinics and other organizations (like Planned Parenthood which hyper conservatives seem to forget offer a lot of very important services for a modest fee beyond abortion) though these only offer very basic care with hit or miss quality. If you do happen to go to the emergency room with no insurance, they treat you like a second class citizen (I was bitten on the face by a brown recluse a couple of years ago, no necrosis fortunately). It's really depressing.

In order to get government assistance for more chronic conditions, you literally have to be so sick you can't work.

Re: American Health Care

Iv`e always heard horror stories about us healthcare, about ambulance attendants asking sick & injured patients if they have health insurance, & leaving them to die if they say no. Iv`e also heard that even if you have health insurance, the companies rufuse to pay up. We in england are always complaining about the nhs, but at least we get health care no matter if we have money or not.

Re: American Health Care

Originally Posted by hairyfairy

Iv`e always heard horror stories about us healthcare, about ambulance attendants asking sick & injured patients if they have health insurance, & leaving them to die if they say no. Iv`e also heard that even if you have health insurance, the companies rufuse to pay up. We in england are always complaining about the nhs, but at least we get health care no matter if we have money or not.

Well, I believe all emergency services (which would include ambulances) have to stabilize you, which means taking you to the ER if need be, but it's after the emergency has passed that you are hanging in the wind.